Depressive symptoms in people with vision impairment: a cross-sectional study to identify who is most at risk

Objective: To identify the risk factors for significant depressive symptoms in people with visual impairment in England and Wales to provide information on who is most at risk and to whom support services could be targeted in future. Design: A cross-sectional study using baseline data from a pragmatic randomised controlled trial. Setting and participants: 990 participants aged 18 or over attending 1 of 14 low-vision rehabilitation primary care optometry-based clinics in South Wales or two hospital clinics in London. Outcome measure: A score of ≥6 on the Geriatric Depression Scale-15 was classed as clinically significant depressive symptoms. Results: In a multivariable logistic regression model, significant depressive symptoms were associated with age (adjusted OR (AOR)=0.82, 95% CI: 0.66 to 0.90, p<0.001), ethnicity (AOR non-white compared with white=1.72, 95% CI: 1.05 to 2.81, p=0.031), total number of eye conditions (AOR for two vs one condition=0.98, 95% CI: 0.67 to 1.43; three or more vs one condition=0.34, 95% CI: 0.15 to 0.75, p=0.026), self-reported health (AOR for excellent vs poor=0.01, 95% CI: 0.00 to 0.12; very good vs poor=0.06, 95% CI: 0.03 to 0.13; good vs poor=0.14, 95% CI: 0.08 to 0.24; fair vs poor=0.28, 95% CI: 0.18 to 0.46, p<0.001) and self-reported visual functioning (AOR=1.45, 95% CI: 1.31 to 1.61, p<0.001). Conclusion: Younger age, a non-white ethnicity, fewer eye conditions and poorer self-reported health and visual function are risk factors for significant depressive symptoms in this population. Trial registration number: ISRCTN46824140; Pre-results

BTS clinical statement for the diagnosis and management of ocular tuberculosis

The BTS clinical statement for the diagnosis and management of ocular tuberculosis (TB) draws on the expertise of both TB and and ophthalmic specialists to outline the current understanding of disease pathogenesis, diagnosis and management in adults. Published literature lacks high-quality evidence to inform clinical practice and there is also a paucity of data from animal models to elucidate mechanisms of disease. However, in order to improve and standardise patient care, this statement provides consensus points with the currently available data and agreed best practice

Oxygen isotope dendrochronology of Llwyn Celyn; One of the oldest houses in Wales

We report the application of oxygen isotope dendrochronology to date a high-status and remarkably unaltered late medieval hall house on the eastern border of South Wales. The oak timbers have either short and complacent ring series, or very strong growth disturbance, and none were suitable for ring-width dendrochronology. By using stable oxygen isotopes from the latewood cellulose, rather than ring widths, it was possible to cross-match and date all 14 timber samples and to provide felling dates related to several phases of building. The hall and solar cross-wing were constructed shortly after 1420CE, which is remarkably early. The house was upgraded using timbers felled in the winter of 1695/6CE by ceiling over of the hall and inserting a chimney. A separate small domestic building was added at the same time and the addition of the kitchen is likely to be contemporaneous. A substantial beast house was added a few years before the house was refurbished, emphasising the importance of cattle as the main source of wealth. A small barn with timbers felled in spring 1843 CE was added later. Llwyn Celyn is one of the most important domestic buildings in Wales, but without the new approach none of the phases of its evolution could have been dated precisely. Oxygen isotope dendrochronology has enormous potential for dating timbers that have small numbers of rings and/or show severe growth disturbance and it works well in regions where tree growth is not strongly constrained by climate. The research was generously supported by the Leverhulme Trust, Natural Environment Research Council, Landmark Trust and the UK National Lottery Heritage Fund

Driving pro-environmental change in tourist destinations: encouraging sustainable travel in National Parks via partnership project creation and implementation

© 2016 Taylor & Francis. This paper explores a key challenge in introducing more sustainable transport practices at destinations: achieving modal shift in visitor travel from cars to physically active or public transport to reduce tourism's environmental impacts. It centres on using partnership led projects bringing together the many public and private sector organisations involved, to drive destination change and development. To date, research has centred on pro-environmental change for individuals and individual organisations: little is known about the mechanisms of pro-environmental change via complex multi-partner organisations. The paper reports research into the processes involved in successful projects to provide alternatives to car travel in three UK National Parks by using partnerships to obtain funding and implement change. Based on case studies informed by in-depth interviews with key stakeholders involved in pro-environmental change implementation, narratives are analysed to explain the change process, and mapped against existing literature and theories of change. Conclusions show the role of inspired individuals, supportive senior management, strong governance, better visitor experiences and, most significantly, communication and communication of the benefits of change to stakeholders. The research suggests why and how change occurs in partnerships, contributes to better theories of change and offers guidance on understanding and implementing change processes worldwide

The Photometric Properties of Isolated Early-Type Galaxies

Isolated galaxies are important since they probe the lowest density regimes inhabited by galaxies. We define a sample of 36 nearby isolated early-type galaxies for further study. Our isolation criteria require them to have no comparable-mass neighbours within 2 B-band magnitudes, 0.67 Mpc in the plane of the sky and 700 km/s in recession velocity. New wide-field optical imaging of 10 isolated galaxies with the Anglo-Australian Telescope confirms their early-type morphology and relative isolation. We also present imaging of 4 galaxy groups as a control sample. The isolated galaxies are shown to be more gravitationally isolated than the group galaxies. We find that the isolated early-type galaxies have a mean effective colour of (B-R)_e = 1.54 +/- 0.14, similar to their high-density counterparts. They reveal a similar colour-magnitude relation slope and small intrinsic scatter to cluster ellipticals. They also follow the Kormendy relation of surface brightness versus size for luminous cluster galaxies. Such properties suggest that the isolated galaxies formed at a similar epoch to cluster galaxies, such that the bulk of their stars are very old. However, our galaxy modelling reveals evidence for dust lanes, plumes, shells, boxy and disk isophotes in four out of nine galaxies. Thus at least some isolated galaxies have experienced a recent merger/accretion event which may have induced a small burst of star formation. We derive luminosity functions for the isolated galaxies and find a faint slope of -1.2, which is similar to the `universal' slope found in a wide variety of environments. We examine the number density distribution of galaxies in the field of the isolated galaxies.Comment: 16 pages, Latex, 17 figures, 6 tables, MNRAS in pres

The depression in visual impairment trial (DEPVIT): trial design and protocol

<b>Background</b> The prevalence of depression in people with a visual disability is high but screening for depression and referral for treatment is not yet an integral part of visual rehabilitation service provision. One reason for this may be that there is no good evidence about the effectiveness of treatments in this patient group. This study is the first to evaluate the effect of depression treatments on people with a visual impairment and co morbid depression.<p></p> <b>Methods/design</b> The study is an exploratory, multicentre, individually randomised waiting list controlled trial. Participants will be randomised to receive Problem Solving Therapy (PST), a ‘referral to the GP’ requesting treatment according to the NICE’s ‘stepped care’ recommendations or the waiting list arm of the trial. The primary outcome measure is change (from randomisation) in depressive symptoms as measured by the Beck’s Depression Inventory (BDI-II) at 6 months. Secondary outcomes include change in depressive symptoms at 3 months, change in visual function as measured with the near vision subscale of the VFQ-48 and 7 item NEI-VFQ at 3 and 6 months, change in generic health related quality of life (EQ5D), the costs associated with PST, estimates of incremental cost effectiveness, and recruitment rate estimation.<p></p> <b>Discussion</b> Depression is prevalent in people with disabling visual impairment. This exploratory study will establish depression screening and referral for treatment in visual rehabilitation clinics in the UK. It will be the first to explore the efficacy of PST and the effectiveness of NICE’s ‘stepped care’ approach to the treatment of depression in people with a visual impairment.<p></p&gt

Genome-wide association study in an admixed case series reveals IL12A as a new candidate in Behçet disease

The etiology of Behçet's disease (BD) is unknown, but widely considered an excessive T-cell mediated inflammatory response in a genetically susceptible host. Recent genome-wide association studies (GWAS) have shown limited number of novel loci-associations. The rarity and unequal distribution of the disease prevalence amongst different ethnic backgrounds have hampered the use of GWAS in cohorts of mixed ethnicity and sufficient sample size. However, novel statistical approaches have now enabled GWAS in admixed cohorts.We ran a GWAS on 336 BD cases and 5,843 controls. The cases consisted of Western Europeans, Middle Eastern and Turkish individuals. Participants from the Generation R study, a multiethnic birth cohort in Rotterdam, The Netherlands were used as controls. All samples were genotyped and data was combined. Linear regression models were corrected for population stratification using Genomic Principal Components and Linear Mixed Modelling. Meta-analysis was performed on selected results previously published.We identified SNPs associated at genome-wide significant level mapping to the 6p21.33 (HLA) region. In addition to this known signal two potential novel associations on chromosomes 6 and 18 were identified, yet with low minor allele frequencies. Extended meta-analysis reveal a GWS association with the IL12A variant rs17810546 on chromosome 3.We demonstrate that new statistical techniques enable GWAS analyses in a limited sized cohort of mixed ethnicity. After implementation, we confirmed the central role of the HLA region in the disease and identified new regions of interest. Moreover, we validated the association of a variant in the IL2A gene by meta-analysis with previous work. These findings enhance our knowledge of genetic associations and BD, and provide further justification for pursuing collective initiatives in genetic studies given the low prevalence of this and other rare diseases

Genome-wide association study in an admixed case series reveals IL12A as a new candidate in Behçet Disease

Introduction: The etiology of Behçet's disease (BD) is unknown, but widely considered an excessive T-cell mediated inflammatory response in a genetically susceptible host. Recent genomewide association studies (GWAS) have shown limited number of novel loci-associations. The rarity and unequal distribution of the disease prevalence amongst different ethnic backgrounds have hampered the use of GWAS in cohorts of mixed ethnicity and sufficient sample size. However, novel statistical approaches have now enabled GWAS in admixed cohorts. Methods: We ran a GWAS on 336 BD cases and 5,843 controls. The cases consisted of Western Europeans, Middle Eastern and Turkish individuals. Participants from the Generation R study, a multiethnic birth cohort in Rotterdam, The Netherlands were used as controls. All samples were genotyped and data was combined. Linear regression models were corrected for population stratification using Genomic Principal Components and Linear Mixed Modelling. Meta-analysis was performed on selected results previously published. Results: We identified SNPs associated at genome-wide significant level mapping to the 6p21.33 (HLA) region. In addition to this known signal two potential novel associations on chromosomes 6 and 18 were identified, yet with low minor allele frequencies. Extended metaanalysis reveal a GWS association with the IL12A variant rs17810546 on chromosome 3. Discussion: We demonstrate that new statistical techniques enable GWAS analyses in a limited sized cohort of mixed ethnicity. After implementation, we confirmed the central role of the HLA region in the disease and identified new regions of interest. Moreover, we validated the association of a variant in the IL2A gene by meta-analysis with previous work. These findings enhance our